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Questions and Answers
A patient recently started on an SSRI reports experiencing persistent nausea and loss of appetite. Which of the following is the MOST appropriate initial intervention?
A patient recently started on an SSRI reports experiencing persistent nausea and loss of appetite. Which of the following is the MOST appropriate initial intervention?
- Immediately discontinue the SSRI and switch to a different class of antidepressant.
- Reassure the patient that these side effects are usually temporary and advise them to take the medication with food. (correct)
- Prescribe an antiemetic medication to alleviate the nausea without altering the antidepressant regimen.
- Increase the dose of the SSRI to potentially override the initial side effects.
A patient with a history of cardiac arrhythmias is being considered for antidepressant therapy. Which of the following factors would make SSRIs a MORE favorable choice than TCAs?
A patient with a history of cardiac arrhythmias is being considered for antidepressant therapy. Which of the following factors would make SSRIs a MORE favorable choice than TCAs?
- TCAs have a faster onset of action compared to SSRIs.
- SSRIs are more effective than TCAs in treating severe depression.
- SSRIs have a lower risk of overdose compared to TCAs. (correct)
- TCAs have a lower incidence of sexual side effects.
A patient taking sertraline (Zoloft) for depression reports feeling increasingly restless and agitated. They also mention experiencing muscle twitching and sweating. What is the MOST important next step?
A patient taking sertraline (Zoloft) for depression reports feeling increasingly restless and agitated. They also mention experiencing muscle twitching and sweating. What is the MOST important next step?
- Monitor the patient for signs of serotonin syndrome and consider reducing or discontinuing the sertraline. (correct)
- Advise the patient that these are expected side effects and will resolve within a few days.
- Prescribe a benzodiazepine to manage the patient's anxiety and agitation.
- Increase the dose of sertraline to improve its effectiveness.
A patient who has been taking paroxetine (Paxil) for several years decides to abruptly stop the medication due to feeling better. Which of the following is the MOST likely consequence of this action?
A patient who has been taking paroxetine (Paxil) for several years decides to abruptly stop the medication due to feeling better. Which of the following is the MOST likely consequence of this action?
A psychiatrist is choosing between an SSRI and a TCA for a patient with depression who also experiences chronic pain. What factor would MOST strongly favor choosing a TCA?
A psychiatrist is choosing between an SSRI and a TCA for a patient with depression who also experiences chronic pain. What factor would MOST strongly favor choosing a TCA?
A patient taking a Tricyclic Antidepressant (TCA) is also prescribed an over-the-counter medication. What is the primary risk associated with this?
A patient taking a Tricyclic Antidepressant (TCA) is also prescribed an over-the-counter medication. What is the primary risk associated with this?
Which of the following is a unique side effect primarily associated with Trazodone (Desyrel) in male patients?
Which of the following is a unique side effect primarily associated with Trazodone (Desyrel) in male patients?
A patient on an SSRI develops symptoms suggestive of serotonin syndrome. Which medication would be MOST appropriate to administer?
A patient on an SSRI develops symptoms suggestive of serotonin syndrome. Which medication would be MOST appropriate to administer?
Electroconvulsive therapy (ECT) may be considered for a patient when:
Electroconvulsive therapy (ECT) may be considered for a patient when:
Which medication is commonly associated with causing increased appetite?
Which medication is commonly associated with causing increased appetite?
A patient is prescribed Desvenlafaxine. What class of antidepressant does this medication belong to?
A patient is prescribed Desvenlafaxine. What class of antidepressant does this medication belong to?
Serotonin syndrome can occur when SSRIs are taken in combination with other substances. Which of the following could potentially contribute to serotonin syndrome when combined with an SSRI?
Serotonin syndrome can occur when SSRIs are taken in combination with other substances. Which of the following could potentially contribute to serotonin syndrome when combined with an SSRI?
Which of the following is _NOT_ a typical characteristic or use associated with Electroconvulsive Therapy (ECT)?
Which of the following is _NOT_ a typical characteristic or use associated with Electroconvulsive Therapy (ECT)?
A patient is prescribed an antidepressant that inhibits the reuptake of both serotonin and norepinephrine. Which of the following medications is MOST likely being prescribed?
A patient is prescribed an antidepressant that inhibits the reuptake of both serotonin and norepinephrine. Which of the following medications is MOST likely being prescribed?
Which of the following side effects is MOST commonly associated with tricyclic antidepressants (TCAs) due to their anticholinergic properties?
Which of the following side effects is MOST commonly associated with tricyclic antidepressants (TCAs) due to their anticholinergic properties?
An elderly patient is prescribed a tricyclic antidepressant (TCA). What potential risk should be carefully monitored in this patient population?
An elderly patient is prescribed a tricyclic antidepressant (TCA). What potential risk should be carefully monitored in this patient population?
A patient taking a selective serotonin reuptake inhibitor (SSRI) reports experiencing sexual dysfunction. Which of the following strategies is LEAST likely to be helpful in managing this side effect?
A patient taking a selective serotonin reuptake inhibitor (SSRI) reports experiencing sexual dysfunction. Which of the following strategies is LEAST likely to be helpful in managing this side effect?
A patient has been taking amitriptyline for several weeks but reports no improvement in their depressive symptoms. What is the MOST appropriate next step in managing this patient's treatment?
A patient has been taking amitriptyline for several weeks but reports no improvement in their depressive symptoms. What is the MOST appropriate next step in managing this patient's treatment?
Which tricyclic antidepressant (TCA) is generally considered to have the fewest anticholinergic side effects?
Which tricyclic antidepressant (TCA) is generally considered to have the fewest anticholinergic side effects?
A patient with pre-existing cardiac conduction issues requires antidepressant therapy. Which class of antidepressants should be used with extreme caution, if at all?
A patient with pre-existing cardiac conduction issues requires antidepressant therapy. Which class of antidepressants should be used with extreme caution, if at all?
A patient is switched from an SSRI to a TCA. What is one of the MOST important considerations during this transition?
A patient is switched from an SSRI to a TCA. What is one of the MOST important considerations during this transition?
Which of the following is an example of an SNRI?
Which of the following is an example of an SNRI?
What is a common risk when prescribing TCAs to older patients?
What is a common risk when prescribing TCAs to older patients?
Flashcards
SSRIs
SSRIs
A class of antidepressants that selectively inhibit the reuptake of serotonin in the brain.
First-line therapy (SSRIs)
First-line therapy (SSRIs)
SSRIs are typically the first choice of medication prescribed for depression due to their favorable side effect profile.
Weight changes with SSRIs
Weight changes with SSRIs
Weight loss may occur short term, while weight gain is more common with long-term use.
SSRI Overdose Risk
SSRI Overdose Risk
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Suicidal ideation (SSRIs)
Suicidal ideation (SSRIs)
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Common SNRIs
Common SNRIs
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Tricyclic Antidepressants (TCAs)
Tricyclic Antidepressants (TCAs)
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TCA Side Effects
TCA Side Effects
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Common TCAs
Common TCAs
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Reuptake
Reuptake
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Serotonin
Serotonin
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Norepinephrine
Norepinephrine
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Sinequan
Sinequan
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TCA - Timing
TCA - Timing
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Herbal products & Serotonin Syndrome
Herbal products & Serotonin Syndrome
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Serotonin Syndrome Treatment
Serotonin Syndrome Treatment
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Trazodone (Desyrel)
Trazodone (Desyrel)
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ECT (Electroconvulsive Therapy)
ECT (Electroconvulsive Therapy)
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ECT Consent
ECT Consent
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Mirtazapine (Remeron)
Mirtazapine (Remeron)
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Trazodone & Priapism
Trazodone & Priapism
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Study Notes
Major Depressive Disorder (MDD)
- Requires symptoms that last a minimum of two weeks for a diagnosis
Subtypes of MDD
- Melancholic subtype includes insomnia, loss of appetite, lack of reactivity to environmental stimuli, and marked anhedonia
- Atypical subtype involves excessive sleep, increased appetite, fatigue/weakness, and extreme sensitivity to rejection
Disruptive Mood Dysregulation Disorder
- Affects children aged 6-18 and involves outbursts and temper tantrums
Dysthymic Disorder
- Persists for at least two years in peers/teens/adults
Premenstrual Dysphoric Disorder
- Symptoms occur one week before a woman gets her period, including anger, anxiety, suicidal thoughts, food cravings/binge eating, irritability, panic attacks, and fatigue/low energy
Substance-Induced Depressive Disorder
- Most likely to have major depressive episodes due to drug/alcohol consumption
- Symptoms usually appear within one month of starting to use medications/alcohol/substances
Depression Statistics
- One in every 20 people suffer from depression
Depression in Infants
- Can display symptoms, and if they have childhood depression, it is likely to occur in the teen/adulthood with higher symptoms/extent
Geriatric Depression
- Someone is old does not automatically mean they will be depressed
Comorbidity
- Depression often occurs with other psychiatric disorders
Seligman's Theory
- Theory of Learned Helplessness
Assessment Tools
- Beck Inventory, Hamilton Depression Scale, Zung Scale, and Geriatric Scale
Symptoms of Depression
- Include depressed mood, anhedonia (inability to experience pleasure), anergia (lack of energy), psychomotor agitation/retardation, and disinterest in sex
Somatic Symptoms
- Not organic but are due to depression such as pain, headache, backache, pain in major organs, and malaise (weakness, discomfort, illness)
Nursing Intervention
- CNA can stay in the room with the patient to ensure their safety
Selective Serotonin Reuptake Inhibitors (SSRIs)
- First-line therapy with low side effects
Side Effects of SSRIs
- Short-term include losing weight and long-term, gaining weight
Examples of SSRIs
- Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), Escitalopram (Lexapro), Paroxetine (Paxil), Fluvoxamine (Luvox)
Monitoring SSRI
- Monitor for thoughts of suicide and instruct patients to inform their healthcare provider if they have such thoughts
Serotonin & Norepinephrine Reuptake Inhibitors (SNRIs)
- Duloxetine (Cymbalta), Venlafaxine (Effexor XR)
Tricyclic Antidepressants (TCAs)
- Carry risks for older adults or patients with heart disease
Side Effects of TCAs
- Dry mouth, blurry vision, tachycardia, photophobia, constipation, urinary retention/hesitancy, and drowsiness
Tricyclic Antidepressant Examples
- Amitriptyline (Elavil), Doxepin (Sinequan), Imipramine (Tofranil), Nortriptyline (Pamelor)
Important Note for TCAs
- It takes time for the medication to work, with small signs appearing in 1-3 weeks
Monoamine Oxidase Inhibitors (MAOIs)
- Requires a strict diet to avoid foods high in tyramine (pepperoni, salami, cheese, coffee, chocolate, beer) because it can cause a hypertensive crisis
MAOI Examples
- Phenelzine (Nardil), Isocarboxazid (Marplan), Selegiline (Emsam), Tranylcypromine (Parnate)
Side Effects of MAOIs
- CNS stimulation, orthostatic hypotension, local rash
Atypical Antidepressants
- Bupropion (Wellbutrin) is an alternative for people who do not like the low libido side effect caused by SSRIs
Medical History Considerations
- Should not be given to an individual who has history of seizures
Other Antidepressant Medications
- Venlafaxine (Effexor), Duloxetine (Cymbalta), Desvenlafaxine (Pristiq), Mirtazapine (Remeron), Trazodone (Desyrel)
Serotonin Syndrome
- Life-threatening emergency due to serotonergic agents, onset is within 24 hours.
- Signs/symptoms: unstable vitals, agitation, sialorrhea (drooling), hyperreflexia, increased tone of lower extremities, hyperactive bowel sounds, and coma
Common Causes of Serotonin Syndrome
- TCAs, SSRIs, lithium, herbal products, antibiotics, OTC medications, and mixing antidepressants with other medications
Electroconvulsive Therapy (ECT)
- Can be a treatment for patients whose medication treatment isn't working
- Only provided to voluntary patients and is not forced
Safety Measures for ECT
- Administer oxygen, blood work, and the patient is put on NPO
Nursing Management
- Monitor heart rate during Electroconvulsive Therapy
Before ECT
- To dry the patient out, Glycopyrrolate is used. -Succinylcholine prevents muscle distress
- Place patient under Methohexitol
Post ECT
- Make sure patient gag reflex is back before eating or drinking
Other Depression Treatments
- Transcranial Magnetic Stimulation (TMS), Vagus Nerve Stimulation, Deep Brain Stimulation (DBS)
- Light Therapy
- St. John's Wort
Light Therapy
- First line treatment for seasonal affective disorder/MDD or dysphoria
- Inhibits secretions of melatonin
Suicide
- Low serotonin levels are related to increased risks of suicide
- Primary prevention involves identifying clients at risk of violence and educating to prevent suicide at risk populations
- Secondary Prevention: Management of the suicide crisis with suicidal patients
- Tertiary Prevention: Nurse offers family and friend support to those who lost someone to suicide, and they also make sure the family doesn't commit
Suicide Risk Factors
- Men are 4x more likely to die from suicide
- Women are 3x more likely to attempt, but not actually die
- Being 45 or older
- Verbal abuse
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